Clinical Decision Support
We want to make sure that you and your staff understand the new PAMA regulatory requirements and can identify the tools that will be required for successful reporting. To support early adoption, we will be rolling out a Medicare Advanced Imaging Referral Form where referring providers or delegates can document which qCDSM was consulted and what the result was. A free web-based tool is available to support AUC consultation:
Ordering providers must utilize a CMS approved Clinical Decision Support tool to perform the AUC Consultation.
As of June 2018, the approved CDMS are:
- AIM Specialty Health ProviderPortal®*
- Applied Pathways CURION™ Platform
- Cranberry Peak ezCDS
- eviCore healthcare’s Clinical Decision Support Mechanism
- MedCurrent OrderWise™
- Medicalis Clinical Decision Support Mechanism
- National Decision Support Company CareSelect™*
National Imaging Associates RadMD
- Sage Health Management Solutions Inc. RadWise®
- Stanson Health’s Stanson CDS
- Test Appropriate CDSM*
*Free Tool Available
Other CDSMs with preliminary qualifications are:
- Applied Cerner CDS mechanism
- Evinance Decision Support
- Flying Aces Speed of Care Decision Support
- Infinx CDSM
- LogicNets’ Decision Engines
- New Century Health’s CarePr
- Reliant Medical Group CDSM
When the ordering provider consults the AUC, the system will indicate whether the clinical information provided for the exam adheres or does not adhere to the AUC.
For Medicare patients, every outpatient advanced imaging procedure will require a modifier.
Modifiers communicate the following:
- If the consultation adhered to the AUC recommendation,
- If the consultation did not adhere to the AUC recommendation or;
- No consultation was required due to an exception for location (e.g., inpatient), type of patient (e.g., emergent) or ordering provider (e.g., hardship).
No. CMS allows the provider’s employed clinical staff to perform the consultation on behalf of the ordering provider. No other entity or individual, including the radiologist may perform the AUC consultation.
Diagnostic Imaging Northwest is working hard to put the pieces in place to make this new CMS requirement as easy as possible for our referring providers. We look forward to sharing those with you soon!
For more information on Medicare and Appropriate Use Criteria, please visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program/index.html